扫频光学相干断层扫描在眼科的应用进展

精准定性、定量评估眼前节及后节的影像学技术,不仅对多种眼病的准确诊断至关重要,同时也可为治疗方案、手术方式以及随访提供重要参考依据.作为一种分辨率高、非接触无创的成像技术,光学相干断层扫描(optical coherence tomography,OCT)已成为玻璃体视网膜相关疾病必不可少的辅助检查工具.近几年提出的扫频光学相干断层扫描成像(swept-source OCT,SS-OCT)技术,具备扫描速度提高及穿透深度加深的优点,同时运用不同成像系统可获得眼部不同层次结构精准的成像.新型的SS-OCT成像技术可用于评估眼前节结构,如角膜移植术后角膜瓣、前房参数等检查,也加深了对玻璃体视网膜相关疾病如糖尿病性黄斑病变、眼底新生血管的转归和黄斑毛细血管扩张等疾病病理形态改变的认识.同时,运用玻璃体增强成像(enhanced vitreous visualization,EVV)、分层扫描(En face SS-OCT)和SS-OCT血管造影等成像系统,可为眼底相关疾病,如玻璃体后脱离、视网膜前膜、视网膜脱离、糖尿病牵拉性视网膜脱离等手术适应证制定最佳的治疗方案并协助术后随访.此外,该技术还为多种眼部疾病如青光眼、眼肿瘤的病理形态学观察提供精准的微结构成像图.本文主要对SS-OCT的技术原理及临床应用进展等方面进行综述.     

扫频光学相干断层成像技术及其在眼科的应用

光学相干断层成像(optical coherence tomography,OCT)自1991年发明以来,在生物成像尤其在眼科和心血流成像中起越来越重要的作用.OCT的发展经历了早期的时域系统及最新的频域系统.其中频域系统又分为谱域OCT(spectral domain OCT,SD-OCT)系统和扫频OCT(swep...     

扫频源光学相干断层扫描血管成像在眼科临床中的应用进展

扫频源光学相干断层扫描血管成像(SS-OCTA)检查是近几年提出的一种新型血管成像技术,具有非侵入性、快速、高分辨率、自动化血管分层成像等优势,在眼科相关疾病的早期诊断、疗效评估及监测疾病进展等方面具有很高的价值。基于OCTA的基础,SS-OCTA采用快速调谐的激光器和1 050 nm的波长,穿透力更强,对视网膜和脉络膜微血管系统进行无创深度分辨成像,加深了对多种眼部疾病(眼底病变、青光眼、神经退行性疾病等)特征的认识。此外,SS-OCTA也可用于研究眼前节结构,如角膜新生血管的深度和密度、虹膜新生血管治疗前后的变化等。该技术为眼科临床实践提供了一种新的手段。本文就SS-OCTA技术在眼科临床的应用进展进行综述。     

Comparison of spectral domain and swept-source optical coherence tomography in pathological myopia

Purpose

To compare optical coherence tomography (OCT) images obtained with swept-source OCT (SS-OCT) and spectral domain OCT (SD-OCT) in pathological myopia.

Methods

This is a comparative observational cases series. Five patients with pathological myopia underwent SD-OCT and SS-OCT imaging. SS-OCT was performed using a prototype system (Topcon Medical Systems). SD-OCT was performed using enhanced depth imaging on the Heidelberg Spectralis OCT. The closest corresponding scans from the central subfield were compared.

Results

Eight eyes of five patients with pathological myopia were included (mean spherical equivalent: −16.00±4.70 D). Overall, SS-OCT better visualized retino-choroidal structures. The choroid, inner segment (IS)/outer segment (OS) line, and external limiting membrane (ELM) were clearly seen in a higher proportion of SS-OCT than SD-OCT scans, (P<0.01 for all) whereas visualization of the sclera and retinal pigment epithelium (RPE) were similar. SS-OCT demonstrated foveoschisis in four eyes, with one of these not visible on SD-OCT. The wider SS-OCT scan revealed additional pathology not visible using SD-OCT along the staphyloma walls in 4/8 images. These included incomplete posterior vitreous detachment in one eye and peripheral retinoschisis in 3/8 eyes. Vitreoschisis was visible in 3/8 SS-OCT images but not in the SD-OCT images.

Conclusion

SS-OCT is useful for imaging the posterior staphyloma of pathological myopia, providing greater detail than SD-OCT.     

不同脉络膜肿瘤光学相干断层扫描影像学特征分析

目的观察不同脉络膜肿瘤,包括脉络膜黑色素瘤、脉络膜骨瘤、脉络膜转移癌及脉络膜血管瘤,在OCT中的影像学特征。方法收集2016年1月至2018年9月在云南省第二人民医院眼科就诊的脉络膜肿瘤患者36例(42眼)的临床资料,其中脉络膜黑色素瘤4例(4眼)、脉络膜血管瘤12例(12眼)、脉络膜转移癌10例(14眼)、脉络膜骨瘤10例(12眼),分析不同肿瘤的OCT影像学特征。结果脉络膜黑色素瘤4眼,OCT均表现为视网膜下多个团状高反射信号,视网膜各层组织被破坏。脉络膜转移癌14眼,OCT表现为脉络膜崎岖不平、波浪状改变,其下隐约可见脉络膜小血管形态,视网膜神经上皮层与色素上皮层脱离,视网膜外层组织内可见大量细颗粒状、团状高反射物堆积。脉络膜骨瘤12眼,10眼OCT示脉络膜层次内一个网状反射影像信号,此处结构与周围脉络膜血管结构完全不同,其后组织反光被遮挡。脉络膜血管瘤12眼,OCT均表现为视网膜下脉络膜隆起,表面光滑,视网膜色素上皮层下反射信号均匀。结论 OCT可作为一项安全有效的眼底影像学检查手段对不同脉络膜肿瘤形态进行观察,结合其他眼底检查手段可为脉络膜肿瘤的诊断和鉴别诊断提供依据。     

Artifacts in optical coherence tomography

Optical coherence tomography (OCT) is now an integral part of management for numerous retinal diseases for diagnosis, treatment planning and follow up. OCT interpretation must involve the understanding of the associated artifacts. These artifacts can mislead physicians to wrong diagnosis or inappropriate management. This review article discusses the various types of artifacts in OCT scans obtained from various devices in various retinal diseases. This article would help to improve the understanding about the various artifacts and their clinical importance.     

光学相干断层扫描血管成像在DR中的诊疗进展

光学相干断层扫描成像(OCT)是眼科影像学中发展最快的技术之一。随着OCT技术逐步改良更新,光学相干断层扫描血管成像(OCTA)随之出现,OCTA在视网膜和脉络膜血流成像中能为多种眼底血管性疾病提供诊疗价值。本文综述了OCTA的原理,以及OCTA观察糖尿病患者眼底的微动脉瘤(MAs)、视网膜缺血、视网膜新生血管(RNV)及其在DR各期组织病理改变的特征、OCTA的局限性及其发展前景。     

Predicting visual outcomes for macular disease using optical coherence tomography

In recent years, the management of macular disease has undergone radical changes, in part because of new therapeutic approaches, but also due to the introduction of a new imaging modality – optical coherence tomography (OCT). The application of OCT imaging has clarified many aspects of chorioretinal disease pathophysiology and elucidated many hitherto unrecognized disease characteristics. From an early stage in its development, OCT has also been revolutionary in attempting to extract clinically useful measurements from image data in an automated fashion. As a result, OCT-derived measurements of retinal thickness have been rapidly embraced in clinical and research settings. However, as knowledge of OCT image analysis has developed, it has become increasingly clear that even accurate measurements of retinal thickness may fail to predict visual outcomes for many diseases. As a result, the focus of much current clinical imaging research is on the identification of other OCT-derived anatomic biomarkers predictive of visual outcomes – such biomarkers could serve as surrogate endpoints in clinical trials and provide prognostic information in clinical practice. In this review, we begin by highlighting the importance of accurate visual function assessment and describing the fundamentals of OCT image evaluation, before describing the current state-of-the-art with regard to predicting visual outcomes, for a variety of macular diseases, using OCT.Abbreviations: ETDRS, Early Treatment Diabetic Retinopathy Study; MPS, Macular Photocoagulation Study; AMD, age-related macular degeneration; OCT, optical coherence tomography; logMAR, logarithm of the minimum angle of resolution; RPE, retinal pigment epithelium; CNV, choroidal neovascularization; ELM, external limiting membrane; IS–OS, inner segment–outer segment; PED, pigment epithelium detachment; CME, cystoid macular edema; ERM, epiretinal membrane; DME, diabetic macular edema; CRVO, central retinal vein occlusion; BRVO, branch retinal vein occlusion; CSC, central serous chorioretinopathy; GA, geographic atrophy     

糖尿病黄斑水肿中光相干断层扫描生物学标志物研究进展

糖尿病视网膜病变(DR)是糖尿病患者常见的眼部并发症,而糖尿病黄斑水肿(DME)是DR患者视力丧失的主要原因,因此DME的早期诊治有重要临床意义。光相干断层扫描(OCT)检查可实现视网膜和脉络膜各个层次的高质量成像,已广泛应用于临床,可用于DME的诊断和治疗效果的长期随访。近年来研究发现DME在OCT图像上视网膜和脉络...     

Anterior segment optical coherence tomography

Optical coherence tomography (OCT) provides non-contact, rapid in vivo imaging of ocular structures, and has become a key part of evaluating the anterior segment of the eye. Over the years, improvements to technology have increased the speed of capture and resolution of images, leading to the increasing impact of anterior segment OCT imaging on clinical practice. In this review, we summarize the historical development of anterior segment OCT, and provide an update on the research and clinical applications of imaging the ocular surface, cornea, anterior chamber structures, aqueous outflow system, and most recently anterior segment vessels. We also describe advancements in anterior segment OCT technology that have improved understanding with greater detail, such as tear film in dry eye disease evaluation, intra-operative real-time imaging for anterior segment surgery, and aqueous outflow with angle assessment for glaucoma. Improvements to image processing and software have also improved the ease and utility of interpreting anterior segment OCT images in everyday clinical practice. Future developments include refinement of assessing vascular networks for the anterior segment, in vivo ultra-high resolution anterior segment optical coherence tomography with histology-like detail, en-face image with 3-dimensional reconstruction as well as functional extensions of the technique.     

State-of-the-art retinal optical coherence tomography

OCT functions as a type of optical biopsy, providing information on retinal pathology in situ and in real time, with resolutions approaching that of excisional biopsy and histopathology. The development of ultrabroad-bandwidth and tunable light sources, as well as high-speed Fourier detection techniques, has enabled a significant improvement in ophthalmic optical coherence tomography (OCT) imaging performance. Three-dimensional, ultrahigh-resolution OCT (UHR OCT) can provide information on intraretinal morphology that is not available from any other non-invasive diagnostic. High-speed imaging facilitates the acquisition of three-dimensional data sets (3D-OCT), thus enabling volumetric rendering and the generation of OCT fundus images that precisely and reproducibly register OCT images to fundus features. The development of broadband light sources emitting at new wavelengths, e.g., approximately 1050 nm, has enabled not only 3D-OCT imaging with enhanced choroidal visualization, but also reduced scattering losses and improved OCT performance in cataract patients. Adaptive optics using high-stroke, deformable mirror technology to correct higher order aberrations in the human eye, in combination with specially designed optics to compensate chromatic aberration along with three-dimensional UHR OCT, has recently enabled in vivo cellular-resolution retinal imaging. In addition, extensions of OCT have been developed to enhance image contrast and to enable non-invasive depth-resolved functional imaging of the retina, thus providing blood flow, spectroscopic, polarization-sensitive and physiological information. Functional OCT promises to enable the differentiation of retinal pathologies via localized, functional retinal response or metabolic properties. These advances promise to have a powerful impact on fundamental as well as clinical studies.     

脉络膜成像技术的进展及其在青光眼临床研究中的应用

脉络膜与青光眼关系的研究一直受限于研究方法而难以深入开展。近年,基于OCT技术的脉络膜成像技术例如增强深部成像OCT（EDI-OCT）和扫频光源OCT（SS-OCT）进入临床应用,青光眼领域借此观察了不同类型青光眼的脉络膜厚度及其有关影响因素,推进了脉络膜厚度与各种青光眼间关系的了解和认识。     

视网膜脱离手术前后黄斑区光学相干断层成像图形特征观察

目的 :观察孔源性视网膜脱离手术前后黄斑区光学相干断层成像 (OCT)的形态特征及临床应用价值。方法 :对 2 8例 2 8眼孔源性视网膜脱离PVRB级以下的患者手术前后黄斑区中心凹进行OCT检查 ,对其图像及与手术前后视力进行分析。结果 :根据 2 8例患者术前临床观察及OCT扫描图像可分为两组四型 ;术后OCT检查显示有 11例 (3 9 2 9% )患者视网膜下仍有微量积液 ;两组四型黄斑中心凹平均RNFL比较无显著性差异 (P >0 0 5 )。结论 :OCT作为一种高分辨率的在眼内获得活体组织横断面的检查仪器 ,能直观、清晰地显示视网膜脱离手术前后黄斑区视网膜横断面的形态特征 ,发现一些临床不易观察的眼底细微改变 ,如黄斑区视网膜神经上皮下微量的积液、视网膜的水肿、囊腔样改变等     

外伤性黄斑病变的OCT特征研究

目的研究外伤性黄斑病变的相干光断层扫描（OCT）图像特征,以总结其患病规律。设计回顾性病例系列。研究对象477例（486眼）4-76岁的外伤性黄斑病变患者。方法回顾及分析2002年9月．2009年6月在北京同仁医院眼科门诊就诊的不同类型外伤性黄斑病变患者的门诊病历资料及OCT图像。主要指标OCT图像特征。结果外伤性黄斑病变的OCT表现主要有九种：黄斑裂孔、神经上皮层脱离、黄斑出血、黄斑水肿、黄斑前膜、脉络膜破裂、黄斑部神经上皮层萎缩薄变、色素上皮层萎缩及脉络膜萎缩。在外伤的早期,较常见的OCT表现为黄斑部色素上皮层萎缩（49．0％）、黄斑裂孔（24．7％）、神经上皮层脱离（26．3％）、黄斑出血（24．2％）、黄斑水肿（19．2％）;在外伤的中晚期,较常见的OCT表现为黄斑部色素上皮层萎缩（63．0％）、神经上皮层萎缩薄变（36．5％）。结论外伤性黄斑病变以多种OCT表现并存为多,黄斑部视网膜色素上皮层萎缩是贯穿外伤早期、中晚期最多的表现。外伤性黄斑病变早期以黄斑裂孔、视网膜脱离、黄斑出血、黄斑水肿为主,中晚期以黄斑部神经上皮层及色素上皮层萎缩为主。（眼科,2009,18：236-238）     

黄斑裂孔的光学相干断层成像分析

目的 探讨黄斑裂孔的光学相干断层成像（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）特征及ＯＣＴ临床应用价值。方法 １９９８年９～１２月临床诊断为黄斑裂孔者共３５例（３８只眼）。经双眼散瞳后进行ＯＣＴ检查,对获取的图像进行分析和测量。结果 １例（１只眼）ＯＣＴ显示为玻璃牵引：１例（１只眼）为黄斑前膜所致的性裂孔：３３例（３６只眼）为黄斑裂孔,其中３例累及双眼。３６只眼中,板层黄     

光学相干断层扫描血管成像（OCTA）在黄斑疾病中的应用进展

光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）是一项新型、无创的成像技术,它可以对视网膜脉络膜血流进行实时成像。相比传统造影剂,OCTA更快捷、安全,并且避免了造影剂相关风险。目前,OCTA已被广泛地应用于眼科临床工作中。本文将对OCTA在黄斑疾病中的临床应用进展进行综述。     

偏振光学相干断层成像技术在临床眼科疾病中的应用

光学相干断层成像（optical coherence tomography,OCT）技术已经成为眼科良好的影像学检查工具。OCT所带来的前所未有的深度分辨率能够对眼前段到后段的组织结构提供很有价值的参考信息。偏振光学相干断层成像技术（polarization-sensitive optical coherence tomography,PS-OCT）在OCT技术的基础上,利用偏振光技术能获得组织层面更多有用的信息。眼部的一些组织,像角膜、视神经纤维层、视网膜色素上皮层能够改变探测光的偏振状态,从而在PS-OCT图像上产生特殊的组织对比,达到观察目的。本文主要就PS-OCT在眼科学方面的发展和现状作一简要介绍,并对其在眼科疾病中的临床应用进行阐述。     

急性视网膜坏死光相干断层扫描图像分析

目的 分析OCT对急性视网膜坏死的诊断价值.方法 回顾分析急性视网膜坏死的眼底照相和OCT图像特征,进行分析总结.结果 炎症急性期OCT显示黄白色视网膜病变的区域视网膜弥漫性水肿渗出呈高反射信号,其下结构反射信号屏蔽;神经上皮层下液体积存,视网膜各层组织结构紊乱.黄斑区OCT图像表现为弥漫性水肿,神经上皮层厚度增加,可见高反射渗出物.炎症消退期坏死区域视网膜与正常视网膜相比厚度明显减少,色素上皮破坏.结论 OCT能提供急性视网膜坏死患者视网膜精细的形态学特征,结合眼底彩照、眼部荧光造影检查对该病能进行较全面而精细的评估.     

En-face optical coherence tomography in the diagnosis and management of age-related macular degeneration and polypoidal choroidal vasculopathy

Optical coherence tomography (OCT) is a noninvasive imaging modality providing high-resolution images of the central retina that has completely transformed the field of ophthalmology. While traditional OCT has produced longitudinal cross-sectional images, advancements in data processing have led to the development of en-face OCT, which produces transverse images of retinal and choroidal layers at any specified depth. This offers additional benefit on top of longitudinal cross-sections because it provides an extensive overview of pathological structures in a single image. The aim of this review was to discuss the utility of en-face OCT in the diagnosis and management of age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). En-face imaging of the inner segment/outer segment junction of retinal photoreceptors has been shown to be a useful indicator of visual acuity and a predictor of the extent of progression of geographic atrophy. En-face OCT has also enabled high-resolution analysis and quantification of pathological structures such as reticular pseudodrusen (RPD) and choroidal neovascularization, which have the potential to become useful markers for disease monitoring. En-face Doppler OCT enables subtle changes in the choroidal vasculature to be detected in eyes with RPD and AMD, which has significantly advanced our understanding of their pathogenesis. En-face Doppler OCT has also been shown to be useful for detecting the polypoid lesions and branching vascular networks diagnostic of PCV. It may therefore serve as a noninvasive alternative to fluorescein and indocyanine green angiography for the diagnosis of PCV and other forms of the exudative macular disease.